Children without health insurance who present to the emergency department (ED) for mental health issues are more likely to be transferred to another hospital compared to kids with private insurance, according to a new study by researchers at the University of California (UC) Davis Children’s Hospital and the UC Davis Department of Psychiatry.

Previous research has shown a significant increase in the number of children and teens presenting to the ED for mental health issues. Between 2012 and 2016, hospital EDs saw a 55 percent jump in kids with mental health problems, according to findings presented at a meeting of the American Academy of Pediatrics in 2018. The increase is highest among minorities.

Transferring a child from one hospital to another creates additional burdens for the patient, family and health care system as a whole. It can add to overcrowding in busy emergency departments, higher costs of care and higher out-of-pocket costs for the family.

For the study, the researchers analyzed a national sample of 9,081 acute mental health events among children in EDs. They looked at the patient’s insurance coverage and a hospital’s decision to admit or transfer patients with a mental health disorder.

“We found that children without insurance are 3.3 times more likely to be transferred than those with private insurance,” said Jamie Kissee Mouzoon, research manager for the Pediatric Telemedicine Program at UC Davis Children’s Hospital and first author on the study.

“The rate was even higher for patients presenting with bipolar disorder, attention-deficit and conduct disorders and schizophrenia.”

The findings, published in the journal Pediatric Emergency Care, reveal gaps in providing equitable and quality care to pediatric patients with mental health emergencies based on their insurance coverage.

According to James Marcin, senior author on the study, there are regulations in place to prevent EDs from making treatment decisions based on the patients’ insurance. Transferring a patient for any other reason than clinical necessity should be avoided.

“Unfortunately, the financial incentives are sometimes hard to ignore and can be even unconscious,” said Marcin, who also is director for the UC Davis Center for Health and Technology and leads the telemedicine program at UC Davis Health.

“What we have found in this study is consistent with other research that demonstrates that patients without health insurance are more likely to get transferred from clinic to clinic or hospital to hospital.”

Marcin is currently looking into how telemedicine — video visits delivered to the children who seek care in remote EDs — might be a solution to the tendency to transfer the patient to another hospital.